Write about our clients

I spent the first night taking care of him, or should I say, shooting him up with dilaudid and valium until his eyes would roll back in his head and he would fall asleep sitting up. “You should try the PO valium,” I coaxed him. “Oh no, I’m much too nauseated,” he would reply.
I gave report in the morning and the nurse replied, “I’ll just throw the kitchen sink at him, I am not a psych nurse.” True, this is an acute care unit, but still this man is not going home with IV dilaudid or valium. I do not feel comfortable loading him up to a point of numb pleasure. There is no psych plan, the meds are ordered, so be it.
The second night he was a begrudged to have me back. “Nothing personal” he assured me. He was polite, and I was polite. Again I told him that the acute phase of his pancreatitis was almost over and that he should consider taking valium my mouth. “You will give me my pain meds IV, right?” “Yes’” I assured him. And once again I lectured him. His lipase was normal now, they didn’t even recheck it. He would not be getting dilaudid when he went him. “Yes, I know,” but “can I also get my valium IV?” he countered.
On the third night, the doctor made rounds at the beginning of my shift. “You know’” I said, “he is receiving 3 milligrams of dilaudid every 4 hours.”
“Lets cut that back.” Dr replied.
“Then, you need to write it and you need to tell him.”
So the doc offered him a strong pain patch and cut down of the dose of dilaudid not much …to 2 mg every 4 hours.
I gave him his dilaudid as ordered, I put the patch on him and he asked immediately for the valium. “No,” I replied,”let me see all my other patients, and I will come back and give you valium.” So the patient decided to request the supervisor. And decided to leave against medical advice.
I called the doc, and let him know what had transpired, “let him have all the valium he wants and if he wants to go AMA, he can go.” Our supervisor was swamped, so our swat nurse stepped in as a mediator. I explain the situation to him, and he reiterated it perfectly, “so, the problem is that he wants more dilaudid and he asked you to ‘stack’ his meds?”
I had given the patient the valium by now, once I had spoken with the MD. I had the valium in my hand and ready to give when the patient told me of his AMA intentions.
The swat offered to remove the patient’s IV access, a PICC line carefully placed into the superior vena cava at the expense of the American tax payer, a line that would have to be replaced if the patient developed acute pancreatitis again. By this time, the patient’s 70 year old mother had shown up with a sleeply 11 year old granddaughter in tow. (Another sad story there)
His last request was to receive his dilaudid before he left.

She is young by today’s standards. Only 64. She had a stroke in the past so she was placed on a blood thinner only to develop bleeding in her brain. So now as the medical team investigates which approach to take next, she is confronted with the reality that life is fleeting. I spent time at her bedside as she expressed her greatest concern: she was worried for her 42 year old son that is a of the many victims of the down-turn in this economy. Will he be able to survive with out her?